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 TB in Eastern Mediterranean Region ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ TB in Eastern Mediterranean Region ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ 6831/21/21 | 2

 ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ 6831/21/21 | 3

Estimated TB incidence rate in EMR Palestine Bahrain Incidence rate (/100 000) > 100 Estimated TB incidence rate in EMR Palestine Bahrain Incidence rate (/100 000) > 100 50 -100 20 -50 < 20 WHO Global 4 | 12/12/1386 TB Report 2007 ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ

Estimated TB incidence in EMR Estimated Incidence l 564, 551 (all forms) l 253, Estimated TB incidence in EMR Estimated Incidence l 564, 551 (all forms) l 253, 316 (smear +) 9 High burden countries l 95% of regional burden l 51% in Pakistan Leading cause of CD death l 113, 000 TB deaths a year 5 | 12/12/1386 l 48, 000 HIV/AIDS deaths, 000, 95 ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ malaria deaths ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ

 Expanded TB Care years 5 last nts in patie ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ Expanded TB Care years 5 last nts in patie ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ on TB milli ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ 1 6831/21/21 | 6

 Expanded TB Care ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ Expanded TB Care ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ 6831/21/21 | 7

Estimated HIV prevalence among TB patients in EMR countries Global TB Report 2007 8 Estimated HIV prevalence among TB patients in EMR countries Global TB Report 2007 8 | 12/12/1386 ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ

 Expanded TB Care ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ Expanded TB Care ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ 6831/21/21 | 9

 ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ 6831/21/21 | 01

Smear-positive case detection rate by DOTS programmes, by WHO region, 1995– 2005 11 | Smear-positive case detection rate by DOTS programmes, by WHO region, 1995– 2005 11 | 12/12/1386 ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ

 ﻣیﺰﺍﻥ ﺷیﻮﻉ ﻣﻨﻄﻘﻪ ﺍی ﺳﻞ ﺩﺭ ﺍﺳیﺎی ﻣﺪیﺘﺮﺍﻧﻪ ﺷﺮﻗی ﺑیﻤﺎﺭی ﺳﻞ یکی ﺍﺯ ﻣیﺰﺍﻥ ﺷیﻮﻉ ﻣﻨﻄﻘﻪ ﺍی ﺳﻞ ﺩﺭ ﺍﺳیﺎی ﻣﺪیﺘﺮﺍﻧﻪ ﺷﺮﻗی ﺑیﻤﺎﺭی ﺳﻞ یکی ﺍﺯ ﺑیﻤﺎﺭیﻬﺎی ﺗﺤﺪیﺪ کﻨﻨﺪﻩ ﺑﺸﺮ ﻣی ﺑﺎﺷﺪ ﺩﺭﺍیﻦ ﻣﻨﻄﻘﻪ ﺳﺎﻟیﺎﻧﻪ ﺣﺪﻭﺩ 000065 ﻧﻔﺮ ﻣﺒﺘﻼ ﺑﻪ ﺳﻞ ﻣی ﺷﻮﻧﺪ ﻭ ﺣﺪﻭﺩ 000011 ﻧﻔﺮ ﺩﺭ ﻃﻮﻝ ﺳﺎﻝ ﺑﻌﻠﺖ ﺳﻞ ﻣی ﻣیﺮﻧﺪ کﻪ ﻣﻌﺎﺩﻝ 003 ﻧﻔﺮ ﺭﻭﺯﺍﻧﻪ ﻣی ﺑﺎﺷﺪ l ﺍﺯ ﺑیﻦ 12 کﺸﻮﺭﻣﺤﻠی ﻣﺪیﺘﺮﺍﻧﻪ ﺷﺮﻗی کﺸﻮﺭﻫﺎی کﻪ ﺍﺯ ﻣیﺰﺍﻥ ﺳﺮﺍﻧﻪ ﻣﻠی پﺎییﻦ ﺗﺮی ﺑﺮ ﺧﻮﺭﺩﺍﺭ ﻣی ﺑﺎﺷﻨﺪ ﺩﺍﺭﺍی ﻣیﺰﺍﻥ ﺷیﻮﻉ ﺑیﺸﺘﺮی ﻫﺴﺘﻨﺪ l پﺎکﺴﺘﺎﻥ ﺑﺎ 000092ﺑیﻤﺎﺭ ﻣﺴﻠﻮﻝ ﺑیﺸﺘﺮیﻦ ﻣیﺰﺍﻥ ﺷیﻮﻉ ﺳﻞ ﻣﻌﺎﺩﻝ 15% ﺳﻞ ﺭﺍ ﺩﺭ کﺸﻮﺭﻫﺎی ﻣﺤﻠی ﺩﺍﺭﺩ l کﺸﻮﺭﻫﺎی ﺍﻓﻐﺎﻧﺴﺘﺎﻥ – ﻣﺼﺮ –ﻋﺮﺍﻕ – ﺍیﺮﺍﻥ – ﻣﻮﺭﻭکﻮ – ﺳﻮﻣﺎﻟی – ﺳﻮﺩﺍﻥ ﻭیﻤﻦ ﺍﺯ ﻧﻈﺮﺷیﻮﻉ ﺩﺭ ﺩﺭﺟﻪ ﺑﻌﺪی ﻣی ﺑﺎﺷﻨﺪ l کﺸﻮﺭ ﺟیﺒﻮﺗی ﺑﺎ ﻣیﺰﺍﻥ ﺑﺮﻭﺯ 267 ﻧﻔﺮﺳﻞ ﺩﺭ ﻫﺮ 000001 ﻧﻔﺮ یکی ﺍﺯ کﺸﻮﺭﻫﺎیی ﺑﺎ ﺍیﻨﺴیﺪﺍﻧﺲ ﺑﺎﻻ ﺩﺭ ﺟﻬﺎﻥ ﺍﺳﺖ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ 6831/21/21 | 21

 Epidemiology of M(X)DR-TB at the global and regional level ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ Epidemiology of M(X)DR-TB at the global and regional level ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ 6831/21/21 | 31

 , Estimated number of MDR-TB cases by regions 5002 ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ , Estimated number of MDR-TB cases by regions 5002 ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ 6831/21/21 | 41

MDR-TB rates in new TB cases, 1994 -2003 (In late 2007, WHO will report MDR-TB rates in new TB cases, 1994 -2003 (In late 2007, WHO will report on a total of 105 countries, 125 settings) 14. 2 Kazakhstan 14. 2 Israel 13. 7 Russia (Tomsk) 13. 2 Uzbekistan 12. 2 Estonia 10. 4 China (Liaoning) 9. 4 Lithuania 9. 3 Latvia 9. 0 Russia (Ivanovo) 7. 8 China (Henan) 6. 6 Dominican Rep 5. 3 Ivory Coast 5. 0 Iran 4. 9 Ecuador 15 | 12/12/1386 ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ

 )6002 Rates of MDR among new TB cases (WHO %3 < %6– 3 )6002 Rates of MDR among new TB cases (WHO %3 < %6– 3 %6 > No estimate ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ 6831/21/21 | 61

 Rates of MDR among previously treated TB cases %6 < % 02 – Rates of MDR among previously treated TB cases %6 < % 02 – 6 %04 – 02 % 04 > No estimate ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ 6831/21/21 | 71

 )5002( Multi-Drug Resistant TB ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ )5002( Multi-Drug Resistant TB ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ 6831/21/21 | 91

XDR-TB Extensively drug-resistant TB (XDR TB) defined as: MDR TB with further resistance to: XDR-TB Extensively drug-resistant TB (XDR TB) defined as: MDR TB with further resistance to: • A fluoroquinolone • One or more of the following injectable drugs: kanamycin, amikacin, capreomycin Source: Global XDR-TB Task Force, 7 -8 October, 2006 20 | 12/12/1386 ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ

XDR-TB – Extensive Drug Resistance The new threat XDR = Resistance to at least XDR-TB – Extensive Drug Resistance The new threat XDR = Resistance to at least INH and RIF (MDR) PLUS resistance to any fluoroquinolone, AND at least one of the second-line injectable drugs (amikacin, kanamycin, or capreomycin) Of 17, 690 isolates from 49 countries during 2000 -2004 20% were MDR and 2% were XDR found in: USA: 4% of MDR Latvia: 19% of MDR S Korea: 15% of MDR found in XDR Southern Africa associated with HIV 21 | 12/12/1386 ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ

Countries with confirmed XDR-TB cases as of February 2007 Georgia Republic of Korea Germany Countries with confirmed XDR-TB cases as of February 2007 Georgia Republic of Korea Germany South Africa Latvia Spain Mexico Sweden Norway Thailand Peru UK Armenia Bangladesh Brazil Canada Chile China, Hong Kong SAR Czech Republic Ecuador France ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ Japan 22 | 12/12/1386 Portugal USA The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO 2005. All rights reserved Argentina Russian Federation Islamic Republic of Iran

Coverage of Anti-Tuberculosis Drug Resistance Surveillance no data estimates sub-national surveys countrywide surveys 23 Coverage of Anti-Tuberculosis Drug Resistance Surveillance no data estimates sub-national surveys countrywide surveys 23 | 12/12/1386 ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ

Latest Global TB Estimates - 2005 Estimated number of cases All forms of TB Latest Global TB Estimates - 2005 Estimated number of cases All forms of TB Multidrug -resistant TB (MDR-TB) Extensively drug-resistant TB (XDR-TB) 8. 8 million 424, 000 27, 000* Estimated number of deaths 1. 6 million 116, 000* * Calculated based on several available estimates 24 | 12/12/1386 ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ

Evolution of drug-resistant TB Drug susceptible TB* MDR-TB XDR-TB 1990 2006 *or limited resistance Evolution of drug-resistant TB Drug susceptible TB* MDR-TB XDR-TB 1990 2006 *or limited resistance Resistance to H&R Manageable with 4 drug regimen DOTS Treatable with 2 nd line drugs 25 | 12/12/1386 Total DR ? Resistance to 2 nd line drugs Resistance to all available drugs Treatment options seriously restricted No treatment options ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ

WHO vision on MDR-TB (2006 -2015) Drug resistance surveillance and management of MDR-TB integrated WHO vision on MDR-TB (2006 -2015) Drug resistance surveillance and management of MDR-TB integrated as routine components of TB control, providing access to diagnosis and treatment for all TB patients and by all health care providers. 26 | 12/12/1386 ﻧﺸﺴﺖ ﺳﺎﻻﻧﻪ ﺑﺮﻧﺎﻣﻪ ﻛﻨﺘﺮﻝ ﺳﻞ ﻣﺎﺯﻧﺪﺭﺍﻥ - ﺑﺎﺑﻠﺴﺮ ﺍﺩﺍﺭﻩ ﻛﻨﺘﺮﻝ ﺳﻞ ﻭ ﺟﺬﺍﻡ